Provider Demographics
NPI:1104445030
Name:FERSCH, MARK DAVID (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:FERSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:63 E PADONIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2306
Mailing Address - Country:US
Mailing Address - Phone:443-589-5252
Mailing Address - Fax:
Practice Address - Street 1:63 E PADONIA RD STE 100
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2306
Practice Address - Country:US
Practice Address - Phone:443-589-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0100636204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM